Behavioral and Motor Improvement After Deep Brain Stimulation of the Globus Pallidus Externus in a Case of Tourette’s Syndrome

Piedimonte, Fabián; Andreani, J; Piedimonte, Leandro; Graff, Pablo; Bacaro, Valeria; Micheli, Federico; Filho, Osvaldo Vilela

doi:10.1111/j.1525-1403.2012.00526.x

Cited by 55 publications

(36 citation statements)

References 15 publications

(12 reference statements)

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“…Anecdotally, we have observed several patients with optimal responses from the dorsal contacts of the electrodes lying within the amGPe. This is consistent with a previous report of efficacy of GPe DBS in TS patients [34]. Therefore, collecting more information about patient comorbidities and tic types in relation to patient-specific simulations and outcomes may help to further individualise targeting.…”

Section: Discussionsupporting

confidence: 80%

Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome

Akbarian-Tefaghi

Akram

Johansson

et al. 2017

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated. Objectives: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood. Methods: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement. Results: A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome. Conclusions: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.

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Section: Discussionsupporting

confidence: 80%

Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome

Akbarian-Tefaghi

Akram

Johansson

et al. 2017

Stereotact Funct Neurosurg

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“…Recent work has suggested that the GPe may be a useful clinical target (Piedimonte et al, 2012), although others also suggest that in the GPi both posteroventral sensorimotor (van der Linden et al, 2002;Shahed et al, 2007;Dehning et al, 2008;Dueck et al, 2009;Martinez-Fernandez et al, 2011) and associative/limbic anteromedial regions (Houeto et al, 2005;Martinez-Fernandez et al, 2011) are effective sites. The data from this study showed that posterior regions were effective; this observation though should be taken with the caveat that the tics observed in this model were induced by focal abnormalities placed into the dorsolateral putamen, which projects strongly to the posterior sensorimotor pallidum.…”

Section: Clinical Relevancementioning

confidence: 99%

“…Typically, the therapy is used for conditions, such as Parkinson's disease and dystonia (Krauss et al, 1999;Starr et al, 2004;Rodriguez-Oroz et al, 2005;Bronstein et al, 2011), yet recently it has also been tried experimentally for treating BG-mediated hyperkinetic motor disorders, such as motor tics and Tourette syndrome (TS) (Vandewalle et al, 1999;van der Linden et al, 2002;Houeto et al, 2005;Shahed et al, 2007;Dehning et al, 2008;Dueck et al, 2009;MartinezTorres et al, 2009;Welter et al, 2010;Azoulay-Zyss et al, 2011;Martinez-Fernandez et al, 2011;Piedimonte et al, 2012). The emerging clinical data with respect to HF-DBS for TS is also supported by positive responses to stimulation in animal models of tourettism McCairn et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Deep Brain Stimulation Reduces Tic-Related Neural Activity via Temporal Locking with Stimulus Pulses

2013

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A neurosurgical intervention that has shown potential for treating basal ganglia (BG) mediated motor tics involves high-frequency deep brain stimulation (HF-DBS) targeted to the output nucleus of the BG: the globus pallidus internus (GPi). This study used a nonhuman primate (Macaca fuscata) model of BG-meditated motor tics, and investigated the short-term neuronal mechanism that might underlie the beneficial effects of GPi-HF-DBS. In parallel with behavioral tic expressions, phasic alterations of neuronal activity emerged in the pallidum following focal disinhibition of the striatum with bicuculline. We delivered HF-DBS in the GPi in such a way that on-stimulation and off-stimulation conditions alternated every 30 s. Analysis of electromyographic (EMG) records showed that during on-stimulation, there were significant reductions in tic-related EMG amplitude. Analysis of pallidal activity showed that GPi-HF-DBS induced both sustained and transient patterns of excitation and inhibition in both segments of the GP. Population-scale firing rates were initially raised relative to baseline, but were not significantly different by the time stimulation ceased. Modulation of behavior and neuronal firing rates were associated with the reduction of tic-related phasic activity in pallidal cells. Examination of short-latency responses showed that firing rate changes were strongly associated with locking of the cells' activity with the HF-DBS pulse. This temporal locking often induced multiphasic changes of firing rates in individual cells, which dynamically changed across the stimulation period. These results support clinical studies that reported success in treating motor tics with GPi-HF-DBS, and demonstrate that the underlying local mechanism within the GP is suppression of tic-related activity through temporal locking with the stimulation pulse.

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“…Muitas pesquisas 23 , relatou estimulação em um caso que apresentou redução de 81% dos tiques 2 anos após a cirurgia (bilateral). O outro, de Piedimonte et al 24 , na Argentina, relatou um caso de sucesso na resposta da estimulação do globo pálido externo, mas que apresentou recaída após o esgotamento das baterias do marcapasso. Um último estudo não citou a localização utilizada do globo pálido 25 .…”

Section: Introductionunclassified

Estimulação cerebral profunda na síndrome de Tourette

Hounie

2014

Debates em Psiquiatria

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Behavioral and Motor Improvement After Deep Brain Stimulation of the Globus Pallidus Externus in a Case of Tourette’s Syndrome

Cited by 55 publications

References 15 publications

Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome

Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome

Deep Brain Stimulation Reduces Tic-Related Neural Activity via Temporal Locking with Stimulus Pulses

Estimulação cerebral profunda na síndrome de Tourette

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